New Hepatitis C Drugs: High Cure Rates, Few Side Effects

Ten years ago at the Liver Meeting the theme was, “Interferon will be the backbone of hepatitis C therapy, forever.” Five years ago at national and international meetings, the buzz was “maybe we can get rid of interferon for a few select patients with chronic hepatitis C.” Yesterday, at the AASLD Liver Meeting in Washington DC, we heard it… “Interferon-free therapy for all will be a reality in the near future.”

Why is this such a big deal to us hepatologists?

Interferon is the chemical our body makes when we fight viruses. It is the chemical which gives us our body aches, chills, nausea and the general feeling that we have been run over by a truck. Therapy for hepatitis C has involved injections of large quantities of this chemical – originally every other day and most recently once a week. This has meant all the unwelcome flu-like symptoms for the entire duration of therapy, 6 months to 18 months. This disrupts work, marriage, leisure and generally, life. All this suffering for cure rates of 30 percent to 80 percent.

High Hep C Cure Rates, Low Side Effect Rates

But all this is changing now, as the FDA is about to approve two new pills: sofosbuvir and simeprevir. There have been recent publications about both drugs in the New England Journal of Medicine, touting their amazing cure rates and lack of side effects. In some patients, these drug regimens will be all oral, and when combined with other pills, they are resulting in cure rates of over 95 percent. In most patients, they will still be combined with interferon, but not for long.

Studies revealed yesterday at the Liver Meeting continue to show us what we are growing to expect, over 90 percent cure rate for hepatitis C patients, with only three to four months of all or mostly pill regimens.

New drugs entering the scene include faldaprevir, deleobuvir, daclatasvir, asunaprevir, alisporivir, ledipasvir and several drugs that don’t have official names yet, only drug company numbers. Amazingly, most of these drug combinations not only deliver cure rates approaching 100 percent in “easy to treat” patients, but all also give us double our current cure rate for those with “difficult to treat virus.” Difficult to treat may include patients who have failed prior therapy, and we saw data from the COSMOS trial (simeprevir combined with sofosbuvir) with 95 percent cure rates using two-pill regimens in these patients.

Better Rates Even for Patients Cirrhosis

Traditionally difficult are those patients with cirrhosis, for whom we saw data from daclatasvir, asunaprevir and BMS-791325 with 100 percent cure rates, and the LONESTAR trial with sofosbuvir and ledipasvir plus or minus ribavirin also with 100 percent cure rate. Impressively, these studies are showing that patients are tolerating the medications well.

The next trials will involve combining multiple drugs into combination pills so patients have to take fewer pills every day. Pre-transplant patients who received sofosbuvir and ribavirin and had undetectable hep C virus for at least 30 days before their transplant usually avoided the normal 100 percent reinfection rate in their newly transplanted liver.

A multi-center study showed that we are also getting ambitious and treating those post- transplant patients – who traditionally had only a 20 percent to 30 percent cure rate – and are now seeing cure rates of 77 percent. Even our patients co-infected with HIV are seeing wonderful successes. Previous regimens had many drug-drug safety issues which prevented their use. Studies presented this week revealed no significant drug interactions and cure rates from hepatitis C to be nearly identical whether a patient had HIV or not.

A New Hard-to-Treat Hep C Variant

Genotype 3 hep C virus has emerged as the newest difficult-to-treat player. Even that is not coming out unscathed with the new meds. Yesterday, we saw evidence of cure rates of 83 percent whether these patients had cirrhosis or not when using the new drugs, combined with interferon. This is the same as the cure rate we have for the best currently available drugs for the easiest to treat patients today.

Mark Sulkowski, MD, completed the hepatitis C debrief with the statement, “We have now seen dramatic changes in how we will manage hepatitis C now and in the near future.”

Boomers Still Need Hep C Screening

Now that U.S. Preventive Services Task Force, the CDC and NIH have all recommended universal screening for baby boomers, we are thrilled that we will have multiple different drugs to offer to those we expect to come to light. Currently, only 70 percent of the baby boomers with the disease even know that they carry the virus. One in 30 baby boomers has the virus, and with new therapy we anticipate that we will be able to cure over 95 percent of them in the next five years. When this occurs, we can greatly decrease the number of people developing cirrhosis and liver cancer, and requiring liver transplant.

We anxiously await not only the FDA’s release, but more importantly, insurance companies’ response as patients and providers will demand these amazing new drugs to cure this huge baby boomer disease.

Dawn Sears, MD is a gastroenterologist, Medical Director Wellness, Chief of Hepatology Section and GI Fellowship Program Director at Scott & White Healthcare in Temple, Texas. Dr. Sears’ patient care emphasis is in autoimmune hepatitis, cirrhosis of the liver and viral hepatitis, among other areas.

Get the latest health updates

Thanks for signing up!

Oops!

A system error was encountered. Please try again later.

Follow us on your favorite social network!

ABOUT THE AUTHOR

Everyday Health Guest Columnist

Everyday Health editors and guest columnists tackle commonly asked questions about health and medical conditions. We provide clear explanations and information that will help you understand what you need to...read more

SEARCH ALL COLUMNS

This site complies with the HONcode standard for trustworthy health information: verify here.

Advertising Notice

This Site and third parties who place advertisements on this Site may collect and use information about
your visits to this Site and other websites in order to provide advertisements about goods and services of
interest to you. If you would like to obtain more information about these advertising practices and to make
choices about online behavioral advertising, please click here.